leadership arranged for me to meet with Leila Karagheusian, the 91-year-old surviving daughter of Mihran
Karagheusian, a New York, N Y, rug manufacturer and
philanthropist who started the Karagheusian Foundation in 1921. After asking many thoughtful and incisive
questions, Ms. Karagheusian wrote a check for $1 million. Eventually, the U.S. Agency for International
Development (USAID) provided a matching grant,
resulting in $3 million in funding for this AGBU
With funding in hand, we contacted Dr. Aznauryan
to explain the two proposed projects. The Minister
of Health chose the offer of a long-term commitment
to education and training to upgrade the Armenian
health care system. He assigned Sevak Avakian, MD,
Deputy Minister of Health for Foreign Affairs in
Armernia, to this effort.
Assembling and training the team
The next step was to select the team of physicians and
nurses from Armenia for training in the U.S.
We had the full support of Yale School of Medicine
and Yale-New Haven Hospital. Paul Barash, MD, chairman, department of anesthesia, and Karen Camp, RN,
deputy director of nursing, surgical services, joined the
team. We had several meetings to plan the selection
process and training curriculum for the Armenian
team. The planning group included the Yale team,
Dr. Avakian, and Regina Ohanyan of the AGBU, who
served as administrative coordinator.
We determined that we would need to train two
surgeons in plastic surgery; two anesthesiologists in
modern anesthesia technology; and 12 nurses in intra-operative, recovery room, intensive care, and floor
nursing care methods. Most importantly, we needed to
train these health care providers in the team approach
in which nurses are accepted partners in patient care
from admission to discharge.
We then concluded that each of the physicians
would need direct, hands-on clinical training; observation alone would be insufficient. Dr. Barash and
I proceeded to apply for formal approval from the
Accreditation Council for Graduate Medical Education for training of the two surgeons in plastic surgery,
and the two anesthesiologists through our two respective residency review committees (RRCs). The RRC for
plastic surgery, under the chairmanship of Leonard T.
Furlow, Jr., MD, FACS, concluded that we had enough
cases to warrant the addition of two residents to our
program, as did the RRC for anesthesia.
For these four physicians to have hands-on clinical
training, they would first need to pass the Educational
Commission for Foreign Medical Graduates (ECFMG)
examination as required under federal law. Any infraction of this requirement would result in immediate
loss of all federal research grants to Yale University.
However, we realized that we would not have time to
teach them enough English language to pass the exam
before their arrival in the U.S.
Our other option was to get Yale University to apply
to the ECFMG for an institutional exemption. I contacted the ECFMG to get instructions on how to apply
for the exemption and in the course of these discussions
the ECFMG’s leadership decided to become a sponsoring institution of the program, thereby eliminating
the need for Yale to apply for such an exemption (see
Figure 1, page 13).
We then traveled to Yerevan to discuss this program
with the Ministry of Health. We asked the Ministry
of Health to select 18 surgeons and 18 anesthesiologists from whom we would select two candidates from
each specialty. We also asked the ministry to select
48 to 50 nurses from whom we would select 12 participants. I also felt it was most important to select
individuals who would be committed to returning to
and remaining in Armenia to ensure the sustainability of our efforts.
TABLE 1. CONSORTIUM
AGBU • Armenian Relief Society • USAID
Plastic and reconstructive surgery center
• American-standard academic plastic surgery section at medical university
Nurse/physician exchange program
• American nurse managers/plastic surgeons to establish training programs in:
Ȗ Mental health/psychiatry
Ȗ Bioengineering for returning medical team